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Significant lung injury and its prognostic significance in acute liver failure: a cohort analysis

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Victor Dong, Ken Sun, Michelle Gottfried, Filipe S Cardoso, Mark J McPhail, R Todd Stravitz, William M Lee, Constantine J Karvellas

Original languageEnglish
Publication statusE-pub ahead of print - 30 Sep 2019

Bibliographical note

© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

King's Authors


BACKGROUND AND AIMS: Respiratory failure complicating acute liver failure (ALF) may preclude liver transplantation (LT). We evaluated the association between significant lung injury (SLI) and important clinical outcomes.

METHODS: Retrospective cohort study of 947 ALF patients with chest radiograph (CXR) and arterial blood gas (ABG) data enrolled in the US Acute Liver Failure Study Group (US-ALFSG) from 01/1998-12/2016. SLI was defined by moderate hypoxemia (Berlin classification; PaO2 /FiO2 <200 mmHg) and abnormalities on CXR. Primary outcomes were 21-day transplant free (TFS) and overall survival.

RESULTS: Of 947 ALF patients, 370 (39%) had evidence of SLI. ALF patients with SLI (ALF-SLI) had significantly worse oxygenation than controls on admission (median PF ratio 120 vs. 300 mmHg, p<0.0001) and higher lactate (6.1 vs. 4.6 mmol/l, p=0.0008). ALF-SLI patients had higher rates of tracheal (19% vs. 14%) and bloodstream (17% vs. 11%, p<0.005 for both) infections and were more likely to receive transfusions (red cells 55% vs 43%; FFP 74% vs 66%; p<0.009 for both). ALF-SLI patients were less likely to receive LT (18% vs. 25%, p=0.02) and had significantly decreased 21-day TFS (34% vs. 42%) and overall survival (49% vs 64%, p<0.007 for both). After adjusting for significant covariates (INR, Bilirubin, acetaminophen etiology) development of SLI was independently associated with decreased 21-day TFS (OR 0.71, p=0.03) in ALF patients (C-index 0.78). Incorporation of SLI improved discriminatory ability of the King's College Criteria (p=0.0061) but not the ALFSG prognostic index (p=0.34).

CONCLUSION: SLI is a common complication in ALF patients that adversely affects patient outcomes.

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